Terrorism – a new dimension in trauma care Zusammenfassung
Bombenanschläge auf die Zivilbevölkerung sind primäre Instrumente des globalen Terrorismus. Angesichts der zunehmend realeren Bedrohungslage auch in Europa gilt es jederzeit vorbereitet zu sein auf die Erfordernisse einer hohen Anzahl von Verletzten und einer neuen Qualität von Verletzungsmustern infolge von Bombenexplosionen. Für die behandelnden Kliniken stellt dies eine außerordentliche große medizinische und logistische Herausforderung dar.
In der vorliegenden Übersichtsarbeit werden zunächst die Grundlagen der Entstehung von Explosionsverletzungen aufgezeigt. Im Anschluss werden die grundsätzlichen Prinzipien von Triage und Polytraumamanagement präsentiert, welche sich an den Vorgaben des ATLS® („advanced trauma life support“) und der DCS („damage control surgery“) orientieren.
Diese sowohl im militärischen als auch im zivilen Umfeld bewährten Behandlungskonzepte mit wiederholter Triage und Lagebeurteilung bilden die Grundlage für verbesserte Behandlungsergebnisse bei der Versorgung des Polytraumas nach terroristischen Bombenanschlägen.
Abstract
Bomb attacks on the civilian population are one of the primary instruments of global terrorism. Confronted as we are with the increasingly real threat in Europe too, we now have to be constantly prepared for the mass casualties and new injury patterns in trauma care that are caused by terrorist bombings. This is extraordinarily challenging, on both medical and logistical levels, for the hospitals involved.
In this review the basic mechanisms of blast injuries are clarified. In addition, the fundamental principles of triage and the management of multiple trauma are presented; these are oriented on ATLS® (advanced trauma life support) and DCS (damage control surgery) guidelines. These treatment concepts, which have proved their worth in both military and civilian environments, involve ongoing triage and constant situational assessment and are the basis of improved treatment results in the care of multiply traumatized victims of terrorist bombings.
Literatur
Aharonson-Daniel L, Klein Y, Peleg K (2006) Suicide Bombers Form a New Injury Profile. Ann Surg 244: 1018–1023
Almogy G, Belzberg H, Mintz Y et al. (2004) Suicide Bombing Attacks – Update and Modifications to the Protocol. Ann Surg 239: 295–303
Ashkenasy-Steuer G, Shamir M, Rivkind A et al. (2005) Clinical Review: The Israeli experience: conventional terrorism and critical care. Crit Care 9: 490–499
Beekley AC, Starnes BW, Sebesta JA (2007) Lessons learned from Modern Military Surgery. Surg Clin N Am 87: 157–184
Cullis IG (2001) Blast waves and how they interact with structures. J R Army Med Corps 147: 16–26
DePalma RG, Burris BG, Champion HR et al. (2005) Blast injuries. N Engl J Med 352:1335–1342
Frykberg ER, Tepas JJ (1988) Terrorist Bombings -- Lessons Learned From Belfast to Beirut. Ann Surg 208: 569–576
Gutierrez de Ceballos J P, Turegano-Fuentes F, Perez-Daias D et al. (2005) 11 March 2004: The terrorist bomb explosions in Madrid, Spain -- an analysis of the logistics, injuries sustained and clinical management of casulties treated at the closest hospital. Crit Care 9: 104–111
Irwin RJ, Lerner MR, Bealer JF et al. (1997) Cardiopulmonary physiology of primary blast injury. J Trauma 43: 650–655
Katz E, Ofek B, Adler J et al. (1989) Primary blast injury after a bomb explosion in a civilian bus. Ann Surg 209: 484–488
Keel M, Trentz O (2005) Pathophysiology of polytrauma. Injury 36: 691–709
Kluger Y, Nimrod A, Biderman P et al. (2006) The Quinary (Vth) injury pattern of blast. J Em Management 4: 51–55
Leibovici D, Gofrit ON, Stein M et al. (1996) Blast injuries: bus versus open-air bombings -- a comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma 41: 1030–1035
Leibovici D, Gofrit ON, Shapira SC (1999) Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med 34: 168–172
Mayo A, Kluger Y (2006) Terrorist bombing. World J Emerg Surg 1: 33
Mellor SG (2006) Military surgery in the 21th Century. J Royal Medical Service 92: 108--113
Pape HC, Aufm‘Kolk M, Paffrath T et al. (1993) Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion -- a cause of posttraumatic ARDS. J Trauma 34: 540–548
Pape HC, Hildebrand F, Pertschy S et al. (2002) Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopaedic surgery. J Trauma 53(3): 452–461
Paran H, Neufeld D, Shwartz I et al. (1996) Perforation of the terminal ileum induced by blast injury: delayed diagnosis or delayed perforation? J Trauma 40: 472–475
Parker PJ (2006) Damage Control Surgery and Casualty evacuation: Techniques for Surgeons, lessons for Military Medical Planners. J R Army Med Corps 152: 202–211
Rotondo MF, Schwab CW, Mc Gonigal MD (1993) Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35: 375–382
Sasser SM, Sattin RW, Hunt RC, Krohmer J (2006) Blast lung injury. Prehosp Emerg Care 10: 165–172
Schwab CW (2004) Introduction: damage control at the start of 21th century. Injury 35: 639–641
Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF (2000) Damage control: collective review. J Trauma 49: 969–978
Stahel PF, Heyde CE, Wyrwich W, Ertel W (2005) Current concepts of polytrauma management. Eur J Trauma 31: 200–211
Tager G, Rucholtz S, Waydhas C et al. (2005) Damage control orthopaedics in patients with multiple injuries is effective, time saving and safe. J Trauma 59: 408–415
Wong JM, Marsh D, Abu-Sitta G et al. (2006) Biological foreign body implantation in victims of the London July 7th suicide bombings. J Tauma 60: 402–404
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Schwab, R., Güsgen, C., Hentsch, S. et al. Terrorismus – Eine neue Dimension des Polytraumas. Chirurg 78, 902–909 (2007). https://doi.org/10.1007/s00104-007-1409-2
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DOI: https://doi.org/10.1007/s00104-007-1409-2